Rural Alaska clinics depend on broadband internet. What happens when it goes out?

Gail Alstrom is operations manager of the St. Mary’s Sub-Regional Clinic. The clinic has about 30 employees, including lab and X-ray technicians, health aides and higher-level health care providers. (Photo by Liz Ruskin/Alaska Public Media)

Think of the tools a doctor needs to assess your health or treat you for disease or injury. Broadband may not have been at the top of the list.

But for rural Alaska, broadband internet service is vital for health care delivery, despite sometimes-tenuous links in the chain that allows health care to function far from the road system.

Take St. Mary’s in the Yukon Delta.

Gail Alstrom points out the sights while bumping along a gravel road in an extended-cab pickup.

“So this is St. Mary’s, and we have about 550 people here,” she told a group of visitors. “The clinic is there on the hill.”

Alstrom is the operations manager at the St. Mary’s Sub-Regional Clinic, part of the Yukon Kuskokwim Health Corp. The clinic has 30 employees and serves a population of 3,000 including surrounding villages, each of which has its own, much smaller clinic.

All of them need a reliable broadband connection.

St. Mary’s is on the meandering Andreafsky River, near its union with the Yukon River. (Photo by Liz Ruskin/Alaska Public Media)

“When things go down, which seems to be a lot, we have to revert back to what we call downtime procedures,” Alstrom said.

It used to be that downtime mostly disrupted telemedicine, like video appointments and remote consultations. But now, even routine visits at rural clinics require broadband service to access the patients’ electronic health records. Alstrom is reminded of it every time an internet outage throws them back in time to the 20th century.

“When our subregional clinic opened, everything was paper. You documented your (patient’s visit) on paper. And then you faxed it. And then you waited. And then you called to make sure it was there, ” she said. “And then you re-faxed it because it probably didn’t make it.”

Alstrom said internet service in St. Mary’s is getting better.

“I think the last real outage spanned about three or four days,” she said. “No internet, no cell phones.”

For a town that’s not on a fiber-optic line, St. Mary’s is relatively fortunate. It’s one of 84 communities on GCI’s TERRA network, a system that draws from fiber-optic and, through a network of towers and mountaintop repeaters, beams broadband into villages on microwaves.

Stewart Ferguson, chief technology officer for the Alaska Native Tribal Health Consortium, said GCI’s system is a big advancement for clinics, particularly in Western Alaska where it’s most prevalent.

“Because of that, that lets us come into villages and do more video, do more telehealth and actually put in electronic health records,” he said, adding that electronic records are becoming essential for patient care.

“It’s where we can look at their history, their allergies, their meds. It’s where we prescribe for them. It’s how we do medical orders. It’s how we can make referrals to the next level care. It’s how we do consultations,” he said. “We can’t almost imagine doing health care without having these modern tools.”

Yet a handful of clinics in Alaska’s tribal health system still get their internet via old-fashioned satellite, and they aren’t able to make the switch to electronic health records — satellite internet is just too slow.

But Ferguson believes the next big thing in Alaska broadband will be … satellites. Specifically, low Earth orbit satellites that will be smaller than the traditional kind and thousands of miles closer.

“The promise is that these will start to appear over Alaska in the next one to two years,” Ferguson said. “And that’s a game changer. Because then you can have high-speed, hopefully low-cost bandwidths, without this latency.”

It could provide the link that finally brings the smallest and most remote Alaska clinics up to speed.

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